OTIPM: A model for implementing top-down, client-centered, and occupation-based assessment, intervention, and documentation

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1 OTIPM: A model for implementing top-down, client-centered, and occupation-based assessment, intervention, and documentation Developed by Professor Anne G. Fisher, ScD, OT, FAOTA The OTIPM rescued me from an OT-depression! Half of my clients did not need OT, they needed physiotherapy. After I learned the OTIPM, I made sure the OT referrals were appropriate and took more time for the interviewing observing goal-setting process, and I focused more on education and compensation. Nothing totally new, but still it changed something. I gained more OT self-esteem and joy in my work. We changed our documentation system. And we threw out the old tests, and now we focus on performance of prioritized activities. Even one of the most body-function-working OT colleagues are enthusiastically reporting that they are reaching goals more easily and faster! Overview Katharina, 2015 This 3-day course is ideal for occupational therapy practitioners, educators, and researchers who want to implement best possible occupation-based and occupation-focused services. The course content progresses step-by-step through the phases of the occupational therapy process. Lectures, video case examples, and extensive opportunities to practice enable the course participants to reflect on and learn strategies they can apply to improve their practice, educational activities, and research. While this course is based on the Occupational Therapy Intervention Process Model (OTIPM, Fisher, 2009; Fisher & Jones, in press). the emphasis is on the practical application of the OTIPM as a professional reasoning model that helps the occupational therapist practice in a more client-centered, top-down, occupation-based, and occupation-focused manner. The occupational therapists who take this course find that they leave inspired to make their practice more centered on occupation. A major premise of the OTIPM is that focusing our evaluations on the client s quality of occupational performance, focusing our interventions directly on enhancing or maintaining occupational performance, and using occupation as a primary method for both evaluation and intervention all depend on a concurrent commitment to true top down and client-centered practice. When we embrace these fundamental principles of occupation-based and occupation-focused services, occupational therapists will: Document measureable and occupation-focused baselines, goals, and outcomes Use occupation-based and occupation-focused evaluation and intervention methods to enhance the quality and effectiveness of the services they provide

2 Advocate for and promote the distinct value of occupational therapy to consumers, third-party payers, and other professionals Value the contributions of occupational therapy to health care and health promotion Background Based on her 1998 Eleanor Clarke Slagle Lectureship, Professor Fisher brings together 50 years of experience to present a model for professional reasoning. The OTIPM is a professional reasoning model that occupational therapists can use to ensure that they adopt an occupation-centered (OC) perspective to guide their reasoning as they plan and implement occupation-based (OB) and occupation-focused (OF) services (Fisher, 2013). In the OTIPM, the occupational therapy process is depicted as occurring over three global phases, evaluation and goal-setting, intervention, and reevaluation, and each step in the process may be OB, OF, or both (Fisher, 2013). The steps of the occupational therapy process defined in the OTIPM are represented schematically below (see Figure 1).

3 Who Should Attend? Occupational therapists who want to change their practice and implement services that are occupation-based and occupation-focused. Occupational therapists who already practice in a manner with which they are satisfied attending this course will enable them to reflect on and evaluate their current practice and identify components that they can further improve so as to become even more occupation-centered. Occupational therapist who want to change practice and are struggling with where to start in order to overcome the many obstacles that limit what they can do. Course Description While the OTIPM is a professional reasoning model, the emphasis of this course is on the practical application of the OTIPM in practice. A variety of individual and group activities provide the course participants with opportunities to implement (a) nonstandardized occupation-focused and occupationbased evaluations of quality of a person s occupational performance, including the performance of daily life tasks that involve social interaction, and (b) occupation-focused documentation. Video case examples are used to reinforce learning. Course Objectives At the conclusion of a 3-day OTIPM workshop, the participants will understand: The occupation-centered professional reasoning process defined in the OTIPM Distinctions between occupation-centered reasoning and occupation-based and occupation-focused practice The various types of evaluations and interventions occupational therapists commonly use and which ones are occupation-based or occupation-focused How to apply true top down and occupation-centered reasoning in the context of implementing occupation-based and occupation-focused services How to implement nonstandardized observation-based performance analyses of a person s quality of occupational performance How to write occupation-focused documentation, including observable and measureable clientcentered goals When and how to link other occupational therapy models of practice and evaluation methods into the occupational therapy intervention process

4 Course Schedule Day 1 8:30 to 10:00 Introduction to the course Developing a common language 10:00 to 10:30 Break 10:30 to 12:00 Introduction to the OTIPM Case application Client-centered performance context 12:00 to 1:15 Lunch 1:15 to 3:00 Case application Client-centered performance context (continued) 3:00 to 3:30 Break 3:30 to 4:30 Document background information, reason for referral, and self-reported level of occupational performance Day 2 8:30 to 10:00 Case application Implement performance analysis (motor and process skills) 10:00 to 10:30 Break 10:30 to 12:00 Case application Document baseline level of performance and clientcentered goals 12:00 to 1:15 Lunch 1:15 to 3:00 Case application Document client-centered goals (continued) 3:00 to 3:30 Break 3:30 to 4:30 Case application Plan intervention Document intervention plan Reevaluate and document result Day 3 8:30 to 9:15 Introduction to a general OT program based on OTIPM 9:15 to 10:00 Case application Implement performance analysis (social interaction skills) 10:00 to 10:30 Break 10:30 to 12:00 Case application Document baseline level of performance and clientcentered, occupation-focused goals 12:00 to 1:15 Lunch 1:15 to 1:45 Case application Plan intervention and evaluate results 1:45 to 3:00 Framing function from an unique occupational therapy perspective Some final thoughts Implementing changes in practice Overcoming obstacles 3:00 to 3:30 Break 3:30 to 4:30 Implementing changes in practice Overcoming obstacles (continued) Final reflections Note. The schedule presented here may vary, depending on group interest and needs. Exact times for breaks and lunch also may vary slightly, depending on the schedule of the course setting.

5 Selected References Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 20, DOI: / Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing top down, client-centered, and occupation-based interventions. Ft. Collins, CO: Three Star Press. Fisher, A. G., & Griswold, L. A. (2013). Performance skills: Implementing performance analyses to evaluate quality of occupational performance. In B. B. Schell, G. Gillen, M. Scaffa, & E. Cohn (Eds.), Willard & Spackman s occupational therapy (12th ed., pp ). Philadelphia: Lippincott Williams & Wilkins. Fisher, A. G., & Jones, K. (in press). Occupational Therapy Intervention Process Model. In P. Kramer, J. Hinojosa, & C. B. Royeen (Eds.). Perspectives In Occupational Therapy (2nd ed.). Philadelphia: F. A. Davis. (Note. For additional references, go to

6 Evaluation and goal-setting phase Intervention phase Reevaluation phase Establish client-centered performance context Identify resources and limitations within client-centered performance context Develop therapeutic rapport and work collaboratively with client Identify client s reported and prioritized strengths and problems of occupational performance Observe client s performance of prioritized tasks and implement performance analyses Define and describe task actions the client does and does not perform effectively Clarify or interpret the reason(s) for client s problems of occupational performance Select the compensatory model Select a model for education and teaching Select a model for occupational skills training (acquisitional model) Plan and implement adaptive occupation to compensate for decreased occupational skill Plan and implement educational programs for groups focused on performance of daily life tasks Plan and implement acquisitional occupation to reacquire or develop occupational skill Reevaluate for enhanced and satisfying occupational performance Establish, finalize, or redefine client-centered and occupation-focused goals Select a model for enhancement of person factors and body functions (restorative model) Plan and implement restorative occupation to restore or develop person factors and body functions Adapted from: Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing top-down, client-centered, and occupation-based interventions. Fort Collins CO: Three Star Press. (Revised June 2013)

7 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet Environmental Client-centered Performance Context: Resources and Limitations Consider past, present, and future or each Role Motivational Task Cultural Social Societal Body function Temporal Adaptation Reason for referral Strengths and Problems of Reported Occupational Performance Tasks performed well and/or with satisfaction Task performed with problems and/or with dissatisfaction Tasks potentially problematic

8 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet Actions (Performance Skills) Performed Effectively or Ineffectively Motor skill Behavior (action) observed Judgment

9 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet Actions (Performance Skills) Performed Effectively or Ineffectively Process skill Behavior (action) observed Judgment

10 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet ADL Motor and ADL Process Skill Specific Baseline Statements Skills included in the cluster Specific baseline statement

11 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet Actions (Performance Skills) Performed Effectively or Ineffectively Social interaction skill Behavior (action) observed Judgment

12 Occupational Therapy Intervention Process Model (OTIPM) Note Taking Worksheet Social Interaction Skill Specific Baseline Statements Skills included in the cluster Specific baseline statement

13 Occupational Therapy Intervention Process Model (OTIPM) Documentation Worksheet Background information Reason for referral Reported current level of performance Priorities Observed current status (global baseline) Actions of performance (performance skills) of most concern (specific baseline) Goals Interpretation Intervention plan Potential to benefit from intervention

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15 References: Occupational Therapy Intervention Process Model (OTIPM) Ericksen, J. B. (2009). Critical reflections on school-based occupational therapy. Scandinavian Journal of Occupational Therapy, 17, Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 20, Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing top down, client-centered, and occupation-based interventions. Ft. Collins, CO: Three Star Press. Fisher, A. G. (2006). Overview of performance skills and client factors. In H. M. Pendleton, & W. Schultz-Krohn (Eds.), Pedretti s occupational therapy: Practice skills for physical dysfunction (6th ed., pp ). St. Louis MO: Mosby Elsevier. Fisher, A. G. (1998). Uniting practice and theory in an occupational framework: 1998 Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 52, Fisher, A. G., Atler, K., & Potts, A. (2007). Effectiveness of occupational therapy with frail community living older adults. Scandinavian Journal of Occupational Therapy, 14, Fisher, A. G., Bryze, K., Hume, V, & Griswold, L. A. (2007). School AMPS: School Version of the Assessment of Motor and Process Skills (2nd ed.). Ft. Collins, CO: Three Star Press. Fisher, A. G., & Griswold, L. A. (2013). Performance skills: Implementing performance analyses to evaluate quality of occupational performance. In B. B. Schell, G. Gillen, M. Scaffa, & E. Cohn (eds.), Willard & Spackman s occupational therapy (12th ed.). Philadelphia: Lippincott Williams & Wilkins. Fisher, A. G., & Griswold, L. A. (2014). Evaluation of Social Interaction (3 nd ed.). Fort Collins, CO: Three Star Press. Fisher, A. G., & Jones, K. B. (in press). Assessment of Motor and Process Skills. Vol. 1: Development, standardization, and administration manual (8th ed.). Fort Collins, CO: Three Star Press. Fisher, A. G., & Jones, K. B. (in press). Occupational Therapy Intervention Process Model. In P. Kramer, J. Honojosa, & C. B. Royeen (Eds.). Perspectives in Occupational Therapy (2nd ed.). Philadelphia: F. A. Davis. Fisher, A. G., & Nyman, A. (2011). OTIPM: En model för ett professionellt resonemang som främjar bästa praxis i arbetsterapi (FOU-rapport 2007) [OTIPM: A model for professional reasoning that promotes best practice in occupational therapy] (revised ed.). Nacka, Sweden: Förbundet Sveriges Arbetsterapeuter.

16 Hällgren, M., & Kottorp, A. (2005). Effects of occupational therapy program in activities of daily living and awareness of disability in persons with intellectual disabilities. Australian Occupational Therapy Journal, 52, Kottorp, A., Hällgren, M., Bernspång, B., & Fisher, A. G. (2003). Client-centred occupational therapy for persons with mental retardation: Implementation of an intervention programme in activities of daily living tasks. Scandinavian Journal of Occupational Therapy, 10, Lindström, M., Hariz, G. M., & Bernspång, B. (2012). Dealing with real-life challenges: Outcome of a home-based occupational therapy intervention for people with severe psychiatric disability. Occupational Therapy Journal of Research, 32, Simmons, D. C., & Griswold, L. A. (2010). Using the Evaluation of Social Interaction in a community-based program for persons with traumatic brain injury. Scandinavian Journal of Occupational Therapy, 17, Zingmark, M., Fisher, A. G., Rocklöv, J., & Nilsson, I. (2014). Occupation-focused interventions for well older people: An exploratory randomized controlled trial. Scandinavian Journal of Occupational Therapy, 21,